The risk of unfavorable outcomes in critically ill patients during interhospital transportation in Tyumen Region

Abstract

The objective: assessment of the risk of unfavorable outcomes in critically ill patients based on the experience of interhospital transportation in Tyumen Region.Methods. The results of 338 patients’ transportation from hospitals of the Tyumen Region for 4 months of 2018 were studied. To assure the group homogeneity, exclusion criteria were used (in order to assess changes in hemodynamic parameters, patients with upcoming or recently performed cardiac surgery, those who had acute myocardial infarction in the last 6 months, were excluded from the study, as well as children under 14 years old, whose hemodynamic parameters depended on the age).Results. Interhospital evacuation of patients at night was statistically significantly associated with lower systolic blood pressure, lower Glasgow coma score, and more often required artificial pulmonary mechanical ventilation (APV) on the way.Conclusions. The severity of the condition of patients undergoing interhospital transfer is closely associated with the state of three systems: respiratory, cardiovascular and central nervous systems. With unfavorable assessment of functions of these systems, the risk of deterioration of the patient's condition during evacuation can accelerate. Tests of these systems’ functions should be the basis of the scales aimed to assess the transportation risk. It was found that impaired consciousness and the need for sedation correlated with condition severity (r = 0.46; p = 0.03) and the need for artificial pulmonary ventilation (r = 0.55; p = 0.05), and if the decision on APV was not made in due time it could serve as a signal to start mechanical ventilation during transportation. Interhospital evacuation at night often requires APV, which in the absence of the timely decision about the patient’s intubation can lead to a deterioration of the condition directly associated with transportation (t = 2.19; p = 0.03) and the increased risk of critical incidents.

Keywords

• interhospital transportation
• evacuation
• critical states
• critical incidents